Lateral cerebellothalamic tract activation underlies DBS therapy for Essential Tremor

While deep brain stimulation (DBS) therapy can be effective at suppressing tremor in individuals with medication-refractory Essential Tremor, patient outcome variability remains a significant challenge across centers. Proximity of active electrodes to the cerebellothalamic tract (CTT) is likely impo...

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Bibliographic Details
Published in:Brain stimulation 2023-03, Vol.16 (2), p.445-455
Main Authors: Brinda, AnneMarie, Slopsema, Julia P., Butler, Rebecca D., Ikramuddin, Salman, Beall, Thomas, Guo, William, Chu, Cong, Patriat, Remi, Braun, Henry, Goftari, Mojgan, Palnitkar, Tara, Aman, Joshua, Schrock, Lauren, Cooper, Scott E., Matsumoto, Joseph, Vitek, Jerrold L., Harel, Noam, Johnson, Matthew D.
Format: Article
Language:English
Subjects:
Cerebellothalamic tract
Deep brain stimulation
Deep Brain Stimulation - methods
Dysarthria - etiology
Dysarthria - therapy
Essential Tremor
Essential Tremor - etiology
Essential Tremor - therapy
Humans
Paresthesia - etiology
Pathway activation models
Thalamus
Treatment Outcome
Tremor - therapy
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Summary:While deep brain stimulation (DBS) therapy can be effective at suppressing tremor in individuals with medication-refractory Essential Tremor, patient outcome variability remains a significant challenge across centers. Proximity of active electrodes to the cerebellothalamic tract (CTT) is likely important in suppressing tremor, but how tremor control and side effects relate to targeting parcellations within the CTT and other pathways in and around the ventral intermediate (VIM) nucleus of thalamus remain unclear. Using ultra-high field (7T) MRI, we developed high-dimensional, subject-specific pathway activation models for 23 directional DBS leads. Modeled pathway activations were compared with post-hoc analysis of clinician-optimized DBS settings, paresthesia thresholds, and dysarthria thresholds. Mixed-effect models were utilized to determine how the six parcellated regions of the CTT and how six other pathways in and around the VIM contributed to tremor suppression and induction of side effects. The lateral portion of the CTT had the highest activation at clinical settings (p 
ISSN:1935-861X
1876-4754
1876-4754
DOI:10.1016/j.brs.2023.02.002